COVID-19

I feel the need to have a place to collect what little I can learn about COVID-19. I am on an immunosuppressive therapy (Ocrevus) that increases my risk for pneumonia and other illnesses. Many people with MS are on immunosuppressive therapies, but not all of us. You should know your own situation and ask your neuro if you need help assessing risk. If you get other recommendations or have other sources of info please comment!

Some links

Good summary of COVID-19: https://www.nejm.org/doi/full/10.1056/NEJMe2002387

Informative article about severe cases: https://www.the-scientist.com/news-opinion/why-some-covid-19-cases-are-worse-than-others-67160

Dr. Aaron Boster on COVID-19 https://www.youtube.com/watch?v=_NpQOR7eXF8 (leaves out ocrevus) and here’s COVID-19 ocrevus: https://www.youtube.com/watch?v=eo_e-d2tJeg

Barts MS on COVID-19: https://multiple-sclerosis-research….0/02/pandemic/

Barts MS on Italian response to community infection by MS neuros: https://multiple-sclerosis-research….over-covid-19/

WHO situation reports on COVID-19 — here you can get info on spread by country, recommendations, updated regularly: https://www.who.int/emergencies/dise…ation-reports/

CreakyJoints COVID-19 page with info and advice: https://awareness.creakyjoints.org/coronavirus/

How to wash hands from WHO (great video but leaves out the step to open door with paper towel): https://www.youtube.com/watch?v=3PmVJQUCm4E

CDC on COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/summary.html

Live data about COVID-19: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Possible recomendations

I have gleaned these from a variety of sources and I am following them because I am on ocrelizumab and I believe that community transmission here will be happening very soon (I’m in Massachusetts in the US). These are specifically for people that are immune compromised or have other conditions that are at risk for more serious responses to COVID-19. Of course, advice of your own doctor or public health department is what you should really listen to!

  1. Consider delaying start of lymphodepleting DMTs such as Ocrelizumab, Alemtuzumab, Rituximab or Cladribine. Talk to your doctor before you stop any DMT — depending on your disease stopping a DMT could be an awful idea!
  2. Avoid crowded places such as cinemas, theatres, schools, etc. Avoid travel on public transit and airplanes if possible. Stay at least a six feet away from other people whenever possible.
  3. Work from home if you work!
  4. Italian neuros are recommending that those on immunosuppressive infusion therapies use protective surgical-grade masks. I don’t see how I could get one of those, but if you’ve got it then use it.
  5. Use caution when touching doors/lightswitches/handrails/etc outside of the home. I have latex gloves that I wear when out. Hand sanitizer is also good when out in the world and carrying tissues or paper towels for door opening.
  6. Use disinfectant wipes around the house and out in the world. I wipe my computer, surfaces, lightswitches, door handles, phone twice a day. Wipe your mobility aids too!
  7. Wash hands with soap whenever you return home, before eating or cooking, after bathroom.
  8. Carry hand sanitizer and use at home and while out. We will run out in another couple of weeks so I have alcohol and aloe on order to make my own (WHOs directions here: https://www.who.int/gpsc/5may/Guide_…Production.pdf)
  9. Cough or sneeze into a disposable tissue and discard. Your sleeve can keep germs for a looooong time.
  10. If I had a disposable mask I’d be using it to stop myself from touching my face (but not for protecting me from germs because that doesn’t work).
  11. I have some zinc lozenges and will probably start taking at some point due to paranoia. There evidence zinc lozenges help with general coronavirus but they are not a cure-all.
  12. Stock up on food that is shelf-stable.
  13. Gyms and swimming. I can’t really find any good info about swimming risk, but did find this: https://www.swimmingworldmagazine.co…irus-in-water/. Overall, gyms and pools are probably best to stay away from for now if you have immune issues. Found a second source that says pools should be chlorinated enough to stop spread https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/environmentalhealthguidance/Advice%20note%20to%20EHS%20on%20Coronavirus%20and%20Drinking%20%20Water%20and%20Swimming%20Pools_V3.pdf
  14. Should members of your family that live with you also restrict their travel and movements? I have not found any articles discussing this. My husband is working from home right now, my kids are still going to school, and the whole family is restricting travel. If things get more intense here we might do some further restriction.
  15. Don’t forget to take care of yourself. I found this article for cancer patients that talked some about exercise, getting outside, good nutrition, and sleeping. From the article: “‘Sleep deprivation is one of the most potent ways of suppressing the immune system,’ Lyman said. ‘Everybody has a different threshold but if you’re not getting a minimum of six or seven or, ideally, eight hours of sleep a night, there’s demonstrable scientific evidence that the immune system may be compromised.’”
  16. If you have cold/flu symptoms call your doctor and talk to them. If you are immune compromised, make sure they know that as they advise you what to do next. If your symptoms start to get more serious, get more serious in your calling. Here’s what I find about what they might do: “There is currently no specific treatment or vaccine against coronavirus-caused respiratory illness. Supportive care is the mainstay of management for all patients including the ones confirmed with SARS, MERS or 2019-nCoV. Oxygen, IV fluids and possible mechanical ventilation may be warranted for all patients with severe clinical presentation. Several antiviral treatments including ribavirin, interferons and the anti-HIV combination lopinavir/ritonavir or remdesivir are under investigation for use against MERS-CoV infection and have been initiated against the 2019-nCoV” (from https://www.ecdc.europa.eu/en/factsh…-coronaviruses).

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